Author Topic: Billingg/coding situation I have never seen before....  (Read 1191 times)

kristin

  • Sr. Member
  • ****
  • Posts: 489
Billingg/coding situation I have never seen before....
« on: April 07, 2015, 08:37:15 PM »
Hi All-

I bill for a podiatrist(Dr. A) who is on staff at a local hospital, and sees patients at the wound care center in that hospital a few days a week. They saw a new patient at the wound care center who had been referred over by another podiatrist (Dr. B) from a different practice, because the patient had wound complications following a partial amputation of two toes by Dr. B. The patient is less than a month into their 90 day global period with Medicare. Dr. A saw the patient at the wound care center, and had to admit them to the hospital that same day and took them to surgery ASAP for these complications, and subsequently ended up doing three different procedures on the patient in three days.

My question is this...what modifier can Dr. A use for billing their first surgery within Dr. B's global period, if any at all? 78 doesn't work, because that is for the same physician who did the original surgery, and that is not Dr. A. There is no transfer of care on record, so 54 and 55 won't work, not to mention one of those modifiers are for outpatient services, and everything Dr. A did was inpatient, because they admitted the patient to the hospital. 

My personal perspective is that Dr. B should have followed up with their patient and dealt with all of the post-op complications/surgeries, and not referred to Dr. A in the first place, but that ship has sailed. So does any one have any advice on how to proceed?

Thanks!

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: Billingg/coding situation I have never seen before....
« Reply #1 on: April 07, 2015, 11:20:31 PM »
Did the initial operating podiatrist (B) not have hospital privileges? Was the amputation done as an outpatient? Is that why this care was referred. I  could see being referred to the wound care center as that is a specialty but wonder if the podiatrist could not admit.. I would be curious about the medical records from podiatrist B.

kristin

  • Sr. Member
  • ****
  • Posts: 489
Re: Billingg/coding situation I have never seen before....
« Reply #2 on: April 08, 2015, 09:41:03 AM »
Hi Merry-

The initial podiatrist does have hospital privileges, at the same hospital that the wound care center is at, and did do the surgery on an outpatient basis there. Ten days later, during a post-op visit in their office, the initial podiatrist did not like the way the surgical site looked, so sent the patient from their office to the wound care center, where my doctor just so happened to be working that day. My doctor made the decision to admit the patient, and did emergency surgery immediately. My assumption, and it is only an assumption, is that the patient could not wait for the initial podiatrist to finish office hours and have surgery later that day, it had to be done ASAP, so therefore, my doctor had to do it, since they were already at the hospital. From there, the patient was now my doctors patient, and all subsequent care/surgery has been done by them.

We have no notes from the initial podiatrist, I am just going on what my doctor told me, and what I can see from the hospital notes since the patient was admitted. I wonder if I am over-thinking this, and no modifier is needed on the first surgery my doctor did at all. The only thing the two doctor share is that they are both podiatrists in the same town. They do not practice together, do not share any EIN/NPI numbers, etc.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4710
    • Solutions Medical Billing
Re: Billingg/coding situation I have never seen before....
« Reply #3 on: April 08, 2015, 10:15:22 AM »
Are you sure 78 wont work?  It doesn't actually say "by same provider".  79 does, but 78 just says "Return to the Operating Room for a Related Procedure During the Postoperative Period".

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

kristin

  • Sr. Member
  • ****
  • Posts: 489
Re: Billingg/coding situation I have never seen before....
« Reply #4 on: April 08, 2015, 10:38:55 AM »
I was looking at the WPS Medicare site for the 78 modifier, and they said this:

"Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period."

So I was basing my rejection of that modifier off of that description, which mentions same physician.